GOVARESH JOURNAL
Year:2017 | Volume:22 | Issue:3|Papers Count:9

IgG4-associated cholangitis (IAC) is a subgroup of IgG4-related disease, which is more common in elderly men. IAC is frequently coincident with autoimmune pancreatitis (AIP). However, some IAC cases do not have other organs involvement. The diagnosis of IAC is based on biochemical, radiological, and histological features. Among these, elevated serum levels of IgG4, extra- and intrahepatic biliary strictures (as visualized by cholangiography), lymphoplasmacytic infiltrations in the liver and bile duct tissue, and association with AIP are of key importance. IAC may mimic primary sclerosing cholangitis or cholangiocarcinoma (CC). It is classically a corticosteroid-responsive condition and corticosteroid is regarded as the initial treatment of choice in this disease. However, relapse following corticosteroid withdrawal is a frequent event.

Background: Common bile duct (CBD) stones exist among 12% of patients with cholelithiasis. They may result in some complications including pancreatitis and cholangitis. The common therapeutical method is endoscopic sphincterotomy during ERCP (Endoscopic Retrograde Cholangio-Pancreatography) and stones removal. This method does not have a reasonable success rate for stones with a diameter larger than 15 mm and may cause serious complications. The aim of this study was to evaluate the CBD stenting method in the treatment of large CBD stones.Materials and Methods: This study was performed on 32 patients who presented to the ERCP unit of Shahid Beheshti hospital in Qom with large CBD stones. Success rate in CBD clearing and rate of some complications including rupture of CBD, pancreatitis, and cholangitis were evaluated after the first ERCP for stent replacement, and the second for its removal.Results: The success rate in complete CBD clearing was 93.8%. A reduction in size and number of stones was seen during a 2-month period, which was statistically significant. No case of CBD rupture and cholangitis was detected and the incidence of pancreatitis was 18.8%.Conclusion: CBD stenting has a reasonable success rate for reducing the size and number of CBD stones.

Background: Colorectal cancer is one of the most common cancers in terms of morbidity and mortality worldwide. A lot of research have been done in this field in Iran and worldwide, which have positive results. The aims of this study were firstly doing a statistical study on colorectal cancer in Mashhad, Iran, and finally predicting the colorectal location of cancer based on the clinical data by using data mining science and decision tree model.Materials and Methods: The data of 316 patients with colorectal cancer (including 14 features) were extracted from the archive of Imam Reza Hospital, Mashhad. The instrument used in this research was Rapid Miner data mining software that would try to be extract the details of the relevant data by statistical surveys and then would do initial simulations and the use of classification and decision tree method have predicteion the location of cancer.Results: Male to female ratio of 56% to 44%, family history of 37%, more young patients, and relatively more distally located cancers (39%) compared with the proximal (35%), and rectum (26%) were the striking findings of this study. The final and most important stage of research models were presented, which was able to predict the location of the cancerous tumor with 80% accuracy.Conclusion: Similarities with global statistics, such as the ratio of men to women and family history were observed. But there were also differences with global statistics including the Iran’s younger patients and relatively more patients with distal cancers. The efficiency of data mining techniques to predict the location of cancer as well as cost reduction was among the most important results of this study.

Background: Inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn’s disease, are chronic and debilitating conditions that their prevalence are growing. These diseases have association with psycho-cognitive factors. This study aimed to evaluate the personality traits of such patients by applying the Minnesota Multiphasic Personality Inventory-2-Restructured Questionnaire.Materials and Methods: We included 100 patients with biopsy proven IBD in this case control study.100 individuals (57 subjects of the patients’ family members and 43 subjects of non-family members) were considered as controls. We applied MMPI-2RF to evaluate the personality traits of the participants. ANOVA was used to compare the mean scales between the three groups.Results: Of this fifty scale-questionnaire, only the scales of emotional inadequacy (mean=59.83±10.42, p=0.047), demoralization (mean=63.00±11.21, p=0.025), malaise (mean=64.99±14.58, p=0.001), cognitive complaints (mean=64.66±15.25, p=0.008), self-doubt (mean=57.55 11.04, p=0.34), and neuroticism (mean=61.43±11.94, p=0.048) had a significant difference between the three groups.Conclusion: The patients with IBD had a higher scales of emotional inadequacy, demoralization, malaise, cognitive complaints, self-doubt, and neuroticism than the controls of non-family and family members. However the differences were significant only between patients with IBD and their non-family controls. We suggest regular psychological and psychiatric counseling for patients with IBD.

Clostridium difficile infection in patients with inflammatory bowel disease (IBD) is associated with more severe disease, longer hospital admission, higher treatment costs, higher risk of colectomy and mortality rate. The classic endoscopic view of the disease is adherent whitish-yellowish multifocal membrane, defined as “psudo-membrane”. Using stool polymerase chain reaction (PCR) is the best way for identifying this organism. Patients with mild to moderate infection are treated with oral metronidazole, while severe infections are treated with oral vancomycin for 10 days. The first recurrence of clostridium difficile infection is treated with the same regimen as the initial episode, however the second recurrence is treated with vancomycin pulse therapy. In the third recurrence, fecal microbiota transplantation (FMT) is one of the treatment choices. This study is a report of three successful FMT in our patients.

Gastrointestinal tract candidiasis is a common infection seen in immunocompromised hosts but occurs most frequently in esophagus. Candidiasis of the stomach and the small intestine is unusual. Herein we describe a 60-year-old woman with a history of diabetes mellitus and hypertension who presented to our hospital with melena, hematemesis, and confusion. She had taken ibuprofen since 2 weeks before the admission. In endoscopic evaluation multiple black and necrotic gastric ulcers in incisura and antrum with active bleeding and one clean base ulcer in the bulb of duodenum was seen. Amphotericin B was started because of highly suspicion to candida or mucormycosis infection. She was discharged from the hospital with well condition. Results of pathological evaluation confirmed candida associated gastric ulcer.

Background: A few studies have shown that during Ramadan, gastrin, pepsin, and acid secretion are increased and some changes in nutrition offasting people may deteriorate dyspepsia symptoms. On the other hand stopping smoking and alcohol use and probable psychosocial factors may improve dyspepsia symptoms.Materials and Methods: The patients with uninvestigated dyspepsia were enrolled in the study during one month before Ramadan and were followed upduring and after Ramadan month. The dyspepsia questionnaires including "The Leeds Dyspepsia Questionnaire (LDQ) " were filled by the patients in three consecutive months. After collecting data they were divided to two groups of fasting and non-fasting and compared using SPSS software.Results: 71 patients finished all three follow up visits (31 fasting and 40 non-fasting). The decreases in LDQ score have been less from before Ramadan to Ramadan and more from Ramadan to after Ramadan in fasting compared with non-fasting groups, but these changes were not significant (p>0.05). Comparing fasting and non-fasting patients, there were not significant differences in score change from before Ramadan to Ramadan or Ramadan to after Ramadan months regarding general satisfaction and various dyspepsia symptoms (p>0.05) except for epigastric discomfort after meal that was more in fasting group from before Ramadan to Ramadan (p=0.004).Conclusion: Ramadan fasting has no effects on various dyspepsia symptoms except for epigastric discomfort after meal, which is aggravated. We recommend that patients with dyspepsia can fast during Ramadan but they are advised not to consume large-volume meals in Iftar and Suhur.

Background: Many patients with irritable bowel syndrome (IBS) may have undiagnosed celiac disease (CD). Diagnosis of CD is important because early diagnosis can prevent serious complications. The purpose of this study was to investigate the demographic features and prevalence of CD in patients with IBS in Khoram Abad, Lorestan.Materials and Methods: This descriptive cross-sectional study was conducted on 369 patients with IBS who were diagnosed based on Rome III criteria and attended to gastrointestinal clinic of Shohada-y-Ashayer Hospital in Khorram Abad from June 2015 until March 2016.31 patients did not accept to participate so were excluded from the study. Serological tests were performed and seropositive cases were underwent upper gastrointestinal endoscopy and duodenal biopsy. Data were analyzed using descriptive statistics, t test and Chi-square test through SPSS software version 22.Results: The mean age of the patients with CD was 31±12 years and most of them (72.7%) were women. Most of CDs were diarrheal dominant IBS (77.3%). Among 338 patients who completed the study, 25 patients (7.4%) were seropositive, and CD was confirmed in 22 of them (6.5%) according to the Marsh classification. Marsh I was reported in seven cases, Marsh II in four, and Marsh III in 11 cases.Conclusion: Considering the high prevalence of CD (6.5%) in patients with IBS, the overlap of the symptoms, as well as the importance oftimely diagnosis of CD, it is suggested to screen CD in patients with IBS.

Population based studies have shown that about 15% of the world population have experienced the symptoms of irritable bowel syndrome (IBS) (1). IBS is a benign condition and usually presents in young women. All cases with IBS have impaired quality of life and anxiety state, but only about 30% of such patients seek help care (2). Despite lack of long term complication, this condition causes significant community health and economic burden due to global distribution of the disease…